Update on Vasectomy Occlusion Techniques
First, two important
qualifying statements:
·
This discussion of techniques must in no way be construed as
recommending one or more techniques over others; it is merely a report on
current practice.
·
No-Scalpel Vasectomy is NOT a method of occlusion; once the vasa
have been delivered through the wall of the scrotum, the practitioner occludes
the vasa using his or her preferred technique.
Occlusion Techniques
The following methods of
occlusion are frequently used in the United States during both conventional
incisional and no-scalpel vasectomy.
1. Ligation with sutures
2. Cauterization
(fulguration)
3. Application of metal
clips
4. Fascial interposition
(not an occlusion technique per se, but used to help guard against
recanalization)
Most Common Methods
A recent (1995) survey
of vasectomists in the United States indicates that cauterization, or
fulguration, of the vasal lumen during vasectomy is the most frequently
employed method of occlusion. Fully 70% of all vasectomists cauterize. The
second most popular occlusion technique involves ligation, used by about 60% of
practitioners. Additionally, about one quarter of all vasectomists occlude by
applying metal clips to the vas deferens. Perhaps of even greater interest to practitioners are the
trends in the use of occlusion methods identified by the
recent study. Physicians want to
know what directions others in the field are taking and why. From the recent
survey, which compared occlusion techniques in 1995 to those used in 1991,
several trends are evident.
First, and most important, in recent
years there has been a clear increase in the reliance on multiple occlusion
methods for each patient. The reason for this trend is not known, but physician
worries about liability in case of failure have probably played a role.
Interestingly, practitioners from
different specialties have come to rely primarily on different combinations of
occlusion techniques. Urologists, for example doubled their use
of cautery -plus- ligation in only four years. Family physicians
increased their use of cautery -plus- clips almost fifteenfold in
those same four years.
Second, in recent years there has
been a marked increase in the use of cauterization, especially by urologists.
In the study, no distinction is drawn between the use of thermal cautery and
electro-cautery, so, t is not known which of the two
methods is now preferred. Schmidt’s 1992 study strongly suggests that thermal
(hotwire) cautery is better because it results in 50 times fewer cases of sperm
granuloma post-vasectomy, but whether physicians follow this in practice is
unknown. Third, the percentage of physicians who use fascial interposition is
rising. Currently over 55% of vasectomists avail themselves of this technique.
Again, concerns about recanalization have probably been a factor in this
change.
References and Resources
Video
No-Scalpel Vasectomy:
The Goldstein Video. Marc Goldstein, M.D., F.A.C.S. of the New York
Hospital–Cornell Medical
Center. Training Video. English. VHS. 1996. Product Number: VED-2
Manual: No-Scalpel Vasectomy: An Illustrated Guide
for Surgeons. Second Edition. New York, AVSC International, 1997. Product
Number: VED-1
Cauteries Product Numbers: AM-21, CH-HI, CT-2121
Articles
1. Haws, J. et al. Clinical
Aspects of Vasectomies Performed in the United States in 1995 Urology,
52: 685-691, 1998
2. Li, S. et al.The
no-scalpel vasectomy. Journal of Urology 145: 341-344, 1991
3. Marquette, C.M. et
al. Vasectomy in the United States, 1991 American Journal of Public Health 85:
644-649, 1995
4. Esho, J.O., and Cass,
A.S. Recanalization rate following methods of vasectomy using interposition of
fascial sheath of vas deferens. Journal of Urology 120: 178-179, 19785.
5. Schmidt, S.S., and Minckler, T.M.
The vas after vasectomy: comparison of cauterization methods. Urology 40:
468-470.
6. Stockton, M.D. et al. No-scalpel
vasectomy: A technique for family physicians. American Family Physician 46:
1153-1164, 1992
7. Schmidt, S.S. Vasectomy by
section, luminal fulguration and fascial interposition: results from 6248
cases. British Journal of Urology 76: 373-374, 1995
© 1998-2006 Advanced Meditech
International, Inc.
Trends in Occlusion